pyschiatric disorder for students.It helps students to have good knowledge regarding mood disorder

for education only.it is one of mental health problem that harm alot of people. It is common disorder

1. 5
By: Lulu A.(MSc in psychiatry)
Mood Disorders

2. Mood Disorders
Objective
At the end of this session the students will be able
to:
Classify mood Disorders
Diagnose a patient with mood Disorders
Manage a patient with mood Disorders

Differentiate mood Disorders from other d/os
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3. Introduction
Mood : pervasive and sustained feeling tone

experienced internally or subjective internal feeling

influences a person's behavior and perception of the world.

Mood can be normal, elevated, or depressed, irritable etc
Affect :the external expression of mood.
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4. MOOD DISORDERS -major classification
1.Depressive disorders
(unipolar mood disorders)
2. Bipolar and Related Disorders
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5. Magnitude of Mood Disorders
Mood disorders are one of the most common
man kind illnesses.
WHO has ranked major depression the 4
th

among the list of the most urgent health problems
worldwide.
Depressive disorder affects one out of five
women & one out of ten men during their lives.
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6. Magnitude…
Bipolar disorders constitute at least 5% in GP.
People affected by mood disorders are at high
risk for suicide & no less than 15% of them
completed suicide.
Many people with mood disorders are disabled.
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7. Incidence and Prevalence

Major depressive episode= 5-17 % TP
Dysthymic disorder= 3-6 %
Bipolar disorder = 2.6-7.8 %
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8. Depression across different age group
Kids
May pretend to be sick,
Worry that a parent is going to die,
poorly in school performance , and refuse to go to
school, or
exhibit behavioural problems (Irritability).
Older people
More willing to discuss the physical
manifestations of depression, instead of emotional
difficulties.
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9. Etiology
There is no single known cause for mood d/os
Biological Factors

Neurotransmitters

NE, DA, 5-HT & histamine disturbance
Thyroid Axis Activity
5 to 10 % of people evaluated for depression have
previously undetected thyroid dysfunction, as
reflected by an elevated basal thyroid-
stimulating hormone (TSH) level.
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10. Etiology…
Genetic Factors
Psychosocial Factors

Life Events and Environmental Stress
Psychodynamic Factors in Depression
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11. 1. Depressive Related disorders
1)Disruptive mood dysregulation disorder
2)Major depressive disorder
3)Persistent depressive disorder (dysthymia)
4)Premenstrual dysphoric disorder
5)Substance/medication-induced depressive d/o,
6)Depressive disorder due to another medical
condition
7)Other specified depressive disorder
8)Unspecified depressive disorder.
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12. 1. Major Depressive Disorder (MDD)
DSM-5 criteria for MDD
A. Five (or more) of the following present during
the same 2-week period and represent a change
from previous functioning;
At least one of the symptoms is either:
(1) depressed mood or (2) loss of
interest/pleasure.
Note: Do not include symptoms that are clearly
attributable to another medical condition.
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13. MDD…
1.Depressed mood most of the day/nearly every day
2.Markedly diminished interest or pleasure
3.Significant weight loss when not dieting or weight
gain or decrease or increase in appetite
4.Insomnia or hypersomnia nearly every day.
5.Psychomotor agitation or retardation
6.Fatigue or loss of energy
7.Feelings of worthlessness or excessive or
inappropriate guilt
8.Diminished ability to think or concentrate
9.Recurrent thoughts of death (suicidal ideation)
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14. MDD…
B. The symptoms cause clinically significant
distress or impairment
C. The episode is not attributable to the
physiological effects of a substance or another
medical condition.
Note: Criteria A-C represent MDE.
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15. 2. Persistent Depressive Disorder (Dysthymia)
New in DSM-5
Include both the DSM-IV TR diagnostic categories of:
A. Chronic MDD and
B. Dysthymia:
Long-standing, depression of at least two years
Fluctuating,
Low-grade depression
Experienced as part of the habitual
A more chronic form of depression,
Diagnosed when the mood disturbance continues for 2 yrs
15Double depression

16. Management
Hospitalization or out patient
A.Pharmacotherapy (Antidepressants)
B.Psychotherapy (psychosocial therapy)

CBT-cognitive behavioural therapy

IPT- interpersonal therapy
C.ECT –electroconvulsive therapy
Pharmacotherapy +psychtherapy most effective Rx.
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17. Antidepressants
Increase levels of serotonin and/or NE
At least 2-5 weeks to work (trial unsuccessful)
65-70% of those on medication got improved
40% will stop taking drugs due to side effects

Relapse rate after going off/ stopping
medications is 50%
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18. Types of Antidepressants
1. Selective Serotonin Reuptake Inhibitors (SSRIs)
Fluoxetine (prozac) preparation ,10mg & 20mg
dose -10mg to 80mg
Sertraline -preparation 25, 50 ,100mg
dose 50-100mg po
2. Tricyclic Antidepressant (TCA)
Block reuptake of NE (to a lesser extent)& serotonin
Amitriptyline, Imipramine
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19. Maintenance treatment
Aim: prevention of new mood episodes/ recurrences
Should be maintained for at least 6 months
Taper the dose gradually over 1 to 2 weeks
Withdrawal before 3 months
Always results in the return of the symptoms.
Patients tend to have more frequent episodes that last
longer.
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20. ECT
For depression that doesn’t respond to other Rxs
Exact mechanism of action is unknown
Treatments every other day for total of 6-10 Rxs
Effective
Side effects: short-term memory loss
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21. Course and prognosis

Depression is an episodic illness
Disappear by itself but recur unless treated well
If untreated,
20% recover within 3 mths, 80% with in 1 year
Risk of another episode increases with
each episode
50%after 1 episode
70%after 2
nd
episode
 90% after 3
rd
episode
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22. 2. Bipolar and Related Disorders
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23. 2. Bipolar and Related Disorders
1.Bipolar I disorder
2.Bipolar II disorder
3.Cyclothymic disorder
4.Substance/medication-induced bipolar and
related disorder
5.Bipolar and related disorder due to AMC
6.Other specified bipolar and related disorder
7.Unspecified bipolar and related disorder
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24. A. Bipolar I disorder (BP-I)
DSM-5 Diagnostic Criteria
Criteria have been met for at least one manic episode
(Criteria A-D under “Manic Episode” below)
The manic episode may have been preceded by and
may be followed by hypomanic or MDEs.
MDEs are common in BP-I disorder but are not
required for the Dx of BP-I disorder (mixed episode?).
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25. Manic Episode
A. Abnormally and persistently elevated, expansive
or irritable mood & increased goal-directed activity or
energy, lasting at least 1 week and present most of
the day (any duration if hospitalization is necessary).
B. Three (or more) of the following symptoms
(four if the mood is only irritable):
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26. Manic Episode…
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep ( feels rested after only 3 hrs).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas/ thoughts racing (subjective experience)
5. Distractibility
6. Increase in goal-directed activity (either socially, at work
or school, or sexually) or psychomotor agitation
7. Excessive involvement in activities that have a high
potential for painful consequences (unrestrained buying
sprees, sexual indiscretions).
DIGFAST
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27. Manic Episode…
C. Marked impairment in social or occupational
functioning or to necessitate hospitalization or
there are psychotic features.
D. The episode is not attributable to the
physiological effects of a substance or to AMC
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28. Hypomanic Episode
A. Abnormally and persistently elevated,
expansive or irritable mood & increased goal-directed
activity or energy, lasting at least 4 consecutive
days and present most of the day
B. ≥ 3 from Criteria-B of manic episodes (four if
the mood is only irritable) have persisted, represent
a noticeable change from usual behaviour
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29. Hypomanic Episode…
C. Unequivocal change in functioning, uncharacteristic
of the individual when not symptomatic.
D. The disturbance in mood and the change in
functioning are observable by others.
E. The episode is not severe enough to cause
marked impairment or to necessitate hospitalization.
If there are psychotic features, the episode is, manic.
F. The episode is not attributable to the physiological
effects of a substance.
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30. B. Bipolar II Disorder
A. At least one hypomanic episode and at least one MDE
B. There has never been a manic episode.
C. The occurrence of the hypomanic episode(s) and MDEs is
not better explained by psychotic disorders.
D. The symptoms of depression or the unpredictability
caused by frequent alternation between periods of
depression and hypomania causes:

clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
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31. C. Cyclothymic Disorder
A. For at least 2 years (at least 1 year in children
and adolescents); numerous periods with:
1)hypomanic symptoms that do not meet criteria for
a manic episode and
2)depressive Sxs that do not meet criteria for a MDE.
B. During the above 2-year period:
the hypomanic and depressive periods have been
present for at least half the time and
without symptoms not for > 2 months at a time.
C. Criteria for a MDE/ME/HME have never been met.
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32. C. Cyclothymic Disorder…
D. The symptoms in Criterion A are not better
explained by psychotic disorders.
E. The symptoms are not attributable to the
physiological effects of a substance or AMC (e.g.,
hyperthyroidism).
F. The symptoms cause clinically significant
distress or impairment in social, occupational,
or other important areas of functioning.
Specify if:
With anxious distress
15-50% risk of developing into Bipolar Disorder
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33. Management of
Bipolar Disorders
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34. Management…
1. Mood stabilizers:
Indications:
Bipolar, cyclothymia, schizoaffective, impulse control

Classes: Lithium and anticonvulsants
2. Antipsychotics
3. Psychotherapy
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35. Management…
I. Lithium
 best known treatment
Not sure how it works
Side effects
Excessive thirst and urination, eventual
damage to kidneys and thyroid
Blood levels must be carefully monitored

Effective
30-60%respond well initially
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36. Management…
II. Atypical and Typical Antipsychotics
All of the atypical antipsychotics have
demonstrated anti-manic efficacy.
Olanzapine, risperidone, quetiapine,
ziprasidone, and aripiprazole.
 Older agents, such as haloperidol ,and CPZ.
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37. Management…
III. Psychosocial treatment
Family therapy:

Increase medication compliance

Educate family about symptoms

Help family develop new coping skills
and communication styles
It helps to decreases relapse
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